Looking beyond the front door

IN OUR DAY TO DAY work, it is easy to become enmeshed in day to day details, such that it can be hard to appreciate the health impacts of the broader environment around us. In previous columns I have talked about how 47% of the population in Blacktown-Mt Druitt have HbA1c screening tests in the diabetic or prediabetic range. I have discussed a layered approach to management integrating hospital and community-based services with support for patients and providers according to needs and experience. There is, however, a step before this which needs to be addressed.

In 2015, Astell-Burt and Feng mapped the availability of fresh food shops, fast food shops and alcohol outlets within a 1.6km radius from a person’s home, comparing Northern Sydney and Western Sydney. While most homes had a greengrocer or supermarket within 1.6km, 6% of those in Western Sydney had neither. Twenty-eight per cent of neighbourhoods in Western Sydney had at least a 3 to 1 ratio of takeaway shops to fresh food shops, compared to 20% in the north. Twelve per cent of neighbourhoods in the west had a 3 to 1 ratio of alcohol outlets to fresh food shops, compared to 5% in the north.

At another level – surveys of Year 8 students across 23 schools in the SALSA (Students as Lifestyle Activists) Projects showed 53% were consuming at least one serve of sugary sweetened beverage a day. It is difficult to separate the issues of knowledge, habit and availability.

As Astell-Burt and Feng point out, “Overall, there is by no means a dearth of alcohol or takeaway options if one lives in the North Shore. But there are multiple venues for purchasing fresh produce within a reasonable walking distance from home should a person choose to do so”.

As a profession and as an association, one of the questions we face is how far does our commitment to better health extend? As individual clinicians, our focus is often on those we are directly caring for, but as a group we have a wider responsibility. Improving healthcare can not be done in isolation without attention to the influence of the natural and built environment. It takes a village to raise a child, but it takes a healthy neighbourhood to raise a healthy child. When it comes to our obesogenic and diabetogenic environment, this is not only about education but includes examining the availability of unhealthy foods and alcohol, and access to healthy alternatives.

The success of smoking cessation programs was not based purely on taxes but on a multipronged approach of education, regulation, excises and behavioural change. As an association, we have been advocating strongly for the development of a national obesity strategy. This will need to be multidimensional, and whole of system. We have called for a tax on sugary sweetened beverages as one component but need to look at local councils, urban planning, walkability and transport. Education campaigns have to be well targeted with the aim of improving not just knowledge but sustained behavioural change. If we are serious about health, we need to look beyond our front door.
This edition of The NSW Doctor magazine includes contributions from Doctors for the Environment Australia (DEA). The DEA is encouraging Government to look at climate change as a health issue, and in this regard, they are also prompting the profession to both think and act outside of the walls of our consultation rooms and hospital corridors.

Focus on members

Despite our focus on the larger issues facing Australians, AMA (NSW) has not lost sight of the issues impacting members.

We have been very active in recent months working on behalf of Northern Beaches Hospital VMOs to secure fair contracts with Healthscope; finalising our second annual Hospital Health Check, which will provide an important advocacy platform to improve working conditions for doctors-in-training; developing resources for specialists to better communicate medical fees with patients; lobbying Government to strengthen privacy concerns with the My Health Record System; strengthening our Future Practice Program to assist members with billing, practice management, IT and accounting; and providing members with seminars and events to help them meet their business and financial goals.